General Assembly Raised Bill No. 5561 seeks to improve Medicaid services and reimbursement rates for various healthcare providers, particularly focusing on cognitive assessments, dental services, and pediatric dental care. Effective July 1, 2026, the bill requires the Commissioner of Social Services to amend the Medicaid state plan to incorporate Medicare billing codes for cognitive assessments for patients aged sixty-four or younger with signs of cognitive impairment. It also mandates prior authorization for most nonemergency dental services while exempting certain preventive and medically necessary treatments from a $1,000 annual payment cap. Additionally, the bill modifies reimbursement rates for safety net pediatric dental clinics to align with federally qualified health centers and expands the council overseeing Medicaid services by adding representatives from the Connecticut Dental Health Partnership.

The legislation further proposes significant changes to reimbursement rates for various healthcare providers, including equalizing rates for optometrists and ophthalmologists, increasing rates for doulas, psychologists, and emergency room physicians, and establishing new provisions for home health care reimbursement. It repeals certain sections of existing law and introduces new provisions that allow for the acceptance of electronic records in the claims process, ensuring streamlined reimbursement for home health care agencies. The bill also emphasizes the importance of nonopioid drugs in pain management, mandates training for prescribing practitioners, and includes provisions for increasing Medicaid reimbursement rates for family planning services. Overall, Raised Bill No. 5561 aims to enhance the quality and accessibility of healthcare services while ensuring fair compensation for providers and addressing the opioid crisis.

Statutes affected:
Raised Bill: 4-220